Primary sarcomatoid carcinoma of the jejunum with massive intra-abdominal hemorrhage: A case report and review of the literature

Jejunal sarcomatoid carcinoma: A case report and review of literature

BACKGROUND

Sarcomatoid carcinoma (SCA) of the jejunum is a rare and aggressive neoplasm affecting the smooth muscle cells of the jejunum. This study presents a recent case of jejunal SCA, detailing its diagnosis and treatment, thereby providing a reference for clinical practice.

CASE SUMMARY

A 65-year-old male presented to Yichang Central People's Hospital with a chief complaint of hemorrhoids. A computed tomography (CT) scan incidentally revealed multiple abnormal signals in the liver. Subsequent positron emission tomography/CT at Wuhan Union Hospital indicated malignant tumor progression, with a primary duodenal tumor and multiple metastases in the upper left abdomen. Intraoperatively, a large tumor was identified on the omentum. Histopathological and immunohistochemical analyses of the resected specimen confirmed the diagnosis of jejunal SCA. The patient received a combination therapy of sintilimab, nanoparticle albumin-bound paclitaxel, and anlotinib. Follow-up imaging demonstrated significant reduction of hepatic and peritoneal lesions. The patient has remained stable for over one year postoperatively.

CONCLUSION

This case suggests that chemotherapy, immunotherapy, plus targeted therapy may represent an optimal treatment for intestinal SCA, meriting further investigation.

Multiple sarcomatoid carcinomas in the small intestine with perforation: A case report and literature review

RATIONALE

Sarcomatoid carcinoma of the small intestine is an exceedingly rare and aggressive malignancy, often diagnosed at advanced stages with a poor prognosis. This study documents a detailed case of sarcomatoid carcinoma of the small intestine, highlighting the diagnostic challenges and treatment approaches, underscored by a comprehensive review of related literature. Given the rarity of this condition, our report aims to enrich the existing diagnostic and treatment frameworks for this malignancy, emphasizing the necessity for early detection and intervention strategies. By presenting this case in conjunction with a literature review, we seek to shed light on the elusive nature of sarcomatoid carcinoma in the small intestine and propose avenues for improving patient outcomes.

PATIENT CONCERNS

Case presentation A 61-year-old male patient initially presented with recurrent abdominal pain and gastrointestinal symptoms. Initial abdominal computed tomography (CT) scans and gastrointestinal endoscopy revealed only inflammatory and hyperplastic changes in the duodenum and jejunum, with a diagnosis of intestinal obstruction. Two years later, due to gastrointestinal perforation, the patient was hospitalized again.

DIAGNOSES

CT scans and other examinations revealed small intestinal lesions. Four small intestinal lesions were surgically removed, and pathology and immunohistochemistry confirmed sarcomatoid carcinoma of the small intestine. A short time later, enhanced CT scans revealed metastatic lesions in the hepatic portal and adrenal glands.

INTERVENTIONS

After surgery, the gastrointestinal function gradually recovered, and the patient was discharged from the hospital on a semiliquid diet. No further treatment such as radiotherapy or chemotherapy was administered postoperatively.

OUTCOMES

Five months after the surgery, the patient died due to brain metastasis.

LESSONS

The study outcomes reveal the aggressive nature of sarcomatoid carcinoma of the small intestine, characterized by rapid progression and poor prognosis despite surgical interventions. The patient condition rapidly deteriorated, leading to metastasis and death within 5 months postsurgery. These findings underscore the critical need for early detection and possibly innovative treatment approaches to improve survival rates. This case also highlights the potential for gastrointestinal sarcomatoid carcinoma to metastasize to distant organs, including the brain, suggesting a propensity for hematogenous spread.

A Rare Presentation of Sarcomatoid Carcinoma of Duodenum: A Case Report

Sarcomatoid tumors are very rare biphasic tumors characterized by a mixture of malignant epithelial and mesenchymal cells that have been usually identified in the lungs with other documented cases in skin, bone, thyroid gland, salivary glands, breast, and genitourinary and gastrointestinal systems. They have an incidence estimated to be 0.5 to 0.8 per 100 000 per year. Three classic features include the presence of a genuine sarcomatous component, no transitional zone between carcinomatous and sarcomatous components, and immunohistochemistry of the sarcomatous component that is positive for mesenchymal markers and negative for epithelial markers. Sarcomatoid carcinoma of the gastrointestinal tract is rare but more commonly found within the stomach, gallbladder, and esophagus. Small bowel involvement is very rare.

Primary Small Intestinal Sarcomatoid Carcinoma: Report of a Rare Case and Literature Review

Sarcomatoid carcinoma (SC) is a rare malignant tumor with properties of both epithelial and mesenchymal carcinomas. SC has been reported in various organs, but the number of reports for each type is small. Small intestinal tumors make up about 3-6% of gastrointestinal malignancies. Discovering them in the early stage is rare and difficult, with anemia and/or abdominal pain as the major symptoms of small intestinal tumors. Primary small intestinal SC (SISC) is rare among small intestinal tumors, and currently very few cases have been reported in the literature. Previous studies have reported that neither chemotherapy nor radiotherapy improves the overall survival rate of patients with SISC, and the prognosis is extremely poor. Currently, surgical resection remains the only optimal therapeutic approach for SISC. Here, we present the case of a 90-year-old woman who had acute peritonitis due to perforation of a small intestinal tumor. She underwent emergency exploratory laparotomy and partial resection of the small intestine, including the tumor. The tumor was pathologically identified as a primary SISC with mesenteric lymph node metastasis. Subsequently, she had recurrence in the intra-abdominal area and lymph node metastasis anterior to the inferior vena cava and died 15 months after surgery without any additional treatment.

[Multiple primary sarcomatoid carcinoma of the jejunum with postoperative lung and brain metastases: a case report and literature review]

We report a rare case of a multiple sarcomatoid carcinoma of the jejunum with postoperative lung and brain metastases. The patient underwent jejunum segmental resection for intussusception and gastrointestinal bleeding. Multiple metastasis ofbrain and lung occurred 4 months after the operation, and the patient died for multiple organ failure 8 months after the surgery. Primary sarcomatoid carcinoma was difficult to diagnose at an early stage, and the diagnosis relies on optical microscopic and immunohistochemical observations. Currently no guidelinesare established for treatment for sarcomatoid carcinoma of the jejunum, and surgical resection remains the optimal therapeutic approach. Previous reports documented a poor prognosis of the patients with a median survival time of 5.5 months (0.36-36months), and the primary causes of death were tumor recurrence and metastasis. Ki-67 as a potential prognostic marker and the value of PD-L1-targeted immunotherapy for the treatment await further investigation.

Primary sarcomatoid carcinoma of the small intestine: very rare and aggressive tumour

Sarcomatoid carcinoma of the small intestine is a very rare and aggressive variant of small intestinal cancers with poor prognosis. The tumour primarily affects middle-aged and older patients with a mean age of 57 years at the time of presentation. We report a woman aged 58 years without any relevant medical history who presented with small intestinal obstruction. She underwent radiologic and endoscopy investigation with persistent features of small bowel obstruction. The patient was found to have a small bowel tumour causing the obstruction and underwent surgical excision of the tumour. Pathology revealed malignant neoplasm with sarcomatoid and epithelioid features involving the terminal ileum. The use of immunohistochemical markers helps in wide range of differential diagnoses. Surgical resection is still considered the best and first-line therapy with poor response to chemotherapy and radiotherapy.

Sarcomatoid carcinoma of the jejunum with gastric metastases: A case report and review of the literature

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Sarcomatoid carcinoma (SCA) of jejunum is an extremely poor prognostic tumor in human being.

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The diagnosis of SCA was based on pathological observations and immunohistochemical staining.

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Surgery is the cornerstones of treatment but the ideal means is still unknown due to the short survival and inadequate reports.

Introduction

Sarcomatoid carcinoma (SCA) of jejunum is an extremely rare condition. To our knowledge, only 17 cases have been reported in the literature.

Presentation

We introduced an additional case of the sarcomatoid carcinoma of jejunum in a 62-year-old Chinese male who presented with epigastric pain for 3 weeks. Multiple tumors originated in the jejunum and metastases to mesentery lymph nodes and distal stomach were found during the laparotomy. The patient underwent palliative resection of the tumors. He died 11 days after the operation.

Discussion

Sarcomatoid carcinoma (SCA) of jejunum is an extremely poor prognostic tumor in human being. The diagnosis of SCA was based on pathological observations and immunohistochemical staining. There is no official treatment guideline for SCA, but wide excision including the tumor is the main goal of treatment.

Conclusion

This is the first case of sarcomatoid carcinoma of jejunum with gastric metastases being reported and also the shortest survival period after the operation. Surgery is the cornerstones of treatment but the ideal means is still unknown due to the short survival and inadequate reports.